| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J9271 |
Inj pembrolizumab |
1,856 |
1,231 |
$27.26M |
| 77386 |
|
9,790 |
962 |
$15.54M |
| J9299 |
Injection, nivolumab |
731 |
388 |
$9.07M |
| J2506 |
Inj pegfilgrast ex bio 0.5mg |
1,194 |
777 |
$5.58M |
| 96413 |
|
17,397 |
9,049 |
$4.53M |
| J9358 |
Inj fam-trastu deru-nxki 1mg |
741 |
264 |
$4.00M |
| J9306 |
Injection, pertuzumab, 1 mg |
448 |
284 |
$3.74M |
| J9144 |
Daratumumab, hyaluronidase |
483 |
254 |
$3.65M |
| 77301 |
|
748 |
645 |
$3.16M |
| 78815 |
|
1,964 |
1,718 |
$2.82M |
| J9355 |
Inj trastuzumab excl biosimi |
841 |
340 |
$2.41M |
| 71260 |
|
4,962 |
4,121 |
$2.04M |
| 74177 |
|
4,079 |
3,313 |
$1.96M |
| 80053 |
|
33,569 |
22,008 |
$1.92M |
| 77334 |
|
1,486 |
1,138 |
$1.83M |
| 99211 |
|
37,133 |
28,947 |
$1.78M |
| 85025 |
|
60,925 |
40,223 |
$1.75M |
| 77300 |
|
1,221 |
1,017 |
$1.74M |
| 70553 |
|
2,816 |
2,497 |
$1.66M |
| G0378 |
Hospital observation per hr |
1,850 |
706 |
$1.57M |
| 99212 |
|
26,520 |
21,999 |
$1.40M |
| 77336 |
|
3,097 |
1,459 |
$1.38M |
| J9202 |
Goserelin acetate implant |
1,185 |
894 |
$1.25M |
| 77412 |
|
2,101 |
339 |
$1.21M |
| 96417 |
|
4,637 |
2,426 |
$1.18M |
| 96415 |
|
3,842 |
1,933 |
$1.05M |
| 76642 |
|
3,358 |
2,895 |
$1.03M |
| 77373 |
|
556 |
169 |
$924K |
| J0185 |
Inj., aprepitant, 1 mg |
1,794 |
1,058 |
$920K |
| J9035 |
Bevacizumab injection |
511 |
133 |
$799K |
| J2997 |
Alteplase recombinant |
702 |
373 |
$799K |
| 77338 |
|
714 |
613 |
$798K |
| J1454 |
Inj fosnetupitant, palonoset |
927 |
525 |
$797K |
| 77295 |
|
335 |
286 |
$689K |
| 80051 |
|
15,692 |
10,601 |
$661K |
| 96416 |
|
1,616 |
753 |
$626K |
| 36591 |
|
8,999 |
5,192 |
$610K |
| J9217 |
Leuprolide acetate suspnsion |
864 |
650 |
$600K |
| 36430 |
|
2,104 |
977 |
$564K |
| J0897 |
Denosumab injection |
231 |
180 |
$546K |
| A9552 |
F18 fdg |
1,826 |
1,601 |
$538K |
| P9037 |
Plate pheres leukoredu irrad |
672 |
228 |
$524K |
| J9173 |
Inj., durvalumab, 10 mg |
47 |
37 |
$489K |
| 88185 |
|
10,654 |
832 |
$482K |
| 38222 |
|
432 |
317 |
$475K |
| J9022 |
Inj, atezolizumab,10 mg |
39 |
30 |
$462K |
| 99213 |
|
6,934 |
5,285 |
$430K |
| 77385 |
|
257 |
24 |
$424K |
| 96402 |
|
3,086 |
2,275 |
$416K |
| 19083 |
|
262 |
215 |
$414K |
| 76536 |
|
1,503 |
1,356 |
$407K |
| 96365 |
|
2,648 |
1,748 |
$401K |
| 77290 |
|
528 |
357 |
$400K |
| 36415 |
|
28,551 |
22,196 |
$400K |
| P9016 |
Rbc leukocytes reduced |
623 |
433 |
$376K |
| 74183 |
|
578 |
470 |
$374K |
| 96375 |
|
10,118 |
5,041 |
$340K |
| 78306 |
|
596 |
485 |
$337K |
| 77066 |
Tomosynthesis, mammo |
1,901 |
1,655 |
$333K |
| 70491 |
|
987 |
833 |
$325K |
| J3490 |
Drugs unclassified injection |
5,877 |
2,725 |
$317K |
| 77049 |
|
360 |
327 |
$303K |
| 88307 |
|
2,343 |
964 |
$285K |
| 31575 |
|
1,404 |
1,228 |
$273K |
| J0791 |
Inj crizanlizumab-tmca 5mg |
26 |
24 |
$255K |
| 80076 |
|
7,356 |
4,700 |
$254K |
| 88305 |
|
6,275 |
2,719 |
$254K |
| 96374 |
|
3,641 |
1,935 |
$252K |
| 88341 |
|
6,326 |
1,088 |
$244K |
| 71250 |
|
1,108 |
897 |
$242K |
| 00320 |
|
358 |
279 |
$239K |
| 72197 |
|
468 |
400 |
$234K |
| Q9968 |
Visualization adjunct |
101 |
50 |
$231K |
| 82565 |
|
21,001 |
14,632 |
$231K |
| 88342 |
|
2,793 |
1,511 |
$225K |
| 31579 |
|
579 |
497 |
$211K |
| 86923 |
|
2,313 |
650 |
$208K |
| 84520 |
|
15,912 |
10,782 |
$206K |
| 36593 |
|
504 |
266 |
$202K |
| P9040 |
Rbc leukoreduced irradiated |
837 |
351 |
$199K |
| 83615 |
|
14,209 |
9,131 |
$193K |
| J9070 |
Cyclophosphamide 100 mg inj |
1,116 |
251 |
$190K |
| 86900 |
|
4,333 |
2,427 |
$189K |
| 97140 |
|
2,367 |
1,192 |
$188K |
| 36592 |
|
3,061 |
1,806 |
$186K |
| 76830 |
|
827 |
719 |
$183K |
| 74178 |
|
346 |
304 |
$178K |
| 77067 |
|
4,051 |
3,672 |
$173K |
| 96411 |
|
1,164 |
676 |
$170K |
| 83735 |
|
9,848 |
4,766 |
$167K |
| 82784 |
|
9,196 |
2,794 |
$165K |
| 96409 |
|
1,033 |
381 |
$159K |
| 88184 |
|
1,096 |
835 |
$157K |
| J1170 |
Hydromorphone injection |
3,568 |
1,448 |
$150K |
| 96401 |
|
1,143 |
510 |
$150K |
| 52000 |
|
252 |
206 |
$150K |
| 81450 |
|
271 |
194 |
$146K |
| 84443 |
|
9,349 |
7,355 |
$139K |
| 77065 |
Tomosynthesis, mammo |
1,051 |
928 |
$138K |
| 84439 |
|
7,712 |
6,083 |
$134K |
| 86850 |
|
4,207 |
2,385 |
$130K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
7,849 |
6,303 |
$124K |
| 76705 |
|
766 |
645 |
$123K |
| G0279 |
Tomosynthesis, mammo |
2,812 |
2,460 |
$121K |
| 36561 |
|
86 |
76 |
$121K |
| 85610 |
|
9,246 |
5,459 |
$112K |
| 0202U |
|
199 |
145 |
$110K |
| J9395 |
Injection, fulvestrant |
400 |
247 |
$110K |
| G0480 |
Drug test def 1-7 classes |
959 |
797 |
$108K |
| 96372 |
|
3,266 |
1,792 |
$108K |
| 86905 |
|
851 |
65 |
$107K |
| 72158 |
|
184 |
157 |
$105K |
| 99202 |
|
1,440 |
1,289 |
$105K |
| 76856 |
|
869 |
757 |
$104K |
| 76641 |
|
181 |
152 |
$102K |
| 88237 |
|
963 |
384 |
$101K |
| 97110 |
|
1,817 |
908 |
$101K |
| J1750 |
Inj iron dextran |
264 |
79 |
$100K |
| J9190 |
Fluorouracil injection |
1,628 |
681 |
$100K |
| 86334 |
|
2,679 |
2,178 |
$98K |
| 82378 |
|
1,862 |
1,387 |
$98K |
| 76942 |
|
568 |
447 |
$95K |
| G0463 |
Hospital outpt clinic visit |
13,586 |
8,224 |
$95K |
| 87799 |
|
1,978 |
694 |
$91K |
| 88360 |
|
1,026 |
328 |
$89K |
| 80307 |
|
3,124 |
2,012 |
$85K |
| 82728 |
|
4,835 |
4,058 |
$85K |
| 96361 |
|
1,867 |
779 |
$84K |
| J9267 |
Paclitaxel injection |
2,085 |
875 |
$84K |
| 77063 |
|
3,827 |
3,452 |
$81K |
| J1459 |
Inj ivig privigen 500 mg |
85 |
36 |
$81K |
| 97535 |
|
1,732 |
1,232 |
$80K |
| J9075 |
Inj, cyclophosphamide, nos |
252 |
70 |
$80K |
| 74176 |
|
266 |
225 |
$78K |
| 00400 |
|
125 |
100 |
$76K |
| 71046 |
|
1,047 |
876 |
$76K |
| 84153 |
|
2,077 |
1,679 |
$76K |
| 87497 |
|
1,154 |
530 |
$75K |
| 96360 |
|
944 |
566 |
$74K |
| 72157 |
|
128 |
112 |
$74K |
| 81206 |
|
313 |
259 |
$74K |
| 82310 |
|
5,280 |
3,944 |
$73K |
| 84165 |
|
2,902 |
2,363 |
$72K |
| 80377 |
|
356 |
271 |
$71K |
| J2469 |
Palonosetron hcl |
5,092 |
2,641 |
$69K |
| 85027 |
|
8,432 |
4,570 |
$68K |
| 97162 |
|
826 |
712 |
$64K |
| 96377 |
|
1,224 |
787 |
$64K |
| J9045 |
Carboplatin injection |
1,974 |
1,030 |
$63K |
| A9800 |
Gallium locametz 1 millicuri |
33 |
25 |
$60K |
| 88313 |
|
1,498 |
565 |
$60K |
| 96367 |
|
2,105 |
1,230 |
$59K |
| 84100 |
|
5,216 |
2,663 |
$59K |
| 76770 |
|
393 |
338 |
$58K |
| 86901 |
|
4,334 |
2,427 |
$56K |
| 72156 |
|
93 |
80 |
$55K |
| 84466 |
|
2,962 |
2,528 |
$53K |
| 92612 |
|
468 |
422 |
$53K |
| A4648 |
Implantable tissue marker |
705 |
573 |
$53K |
| J9171 |
Docetaxel injection |
518 |
289 |
$50K |
| 88264 |
|
419 |
313 |
$50K |
| 88275 |
|
1,528 |
242 |
$50K |
| 96376 |
|
2,224 |
994 |
$48K |
| J9201 |
In gemcitabine hcl nos 200mg |
1,466 |
406 |
$47K |
| J9206 |
Irinotecan injection |
867 |
254 |
$47K |
| A9587 |
Gallium ga-68 |
15 |
13 |
$46K |
| 84432 |
|
803 |
678 |
$45K |
| 86920 |
|
580 |
121 |
$43K |
| 88271 |
|
1,753 |
255 |
$42K |
| J2704 |
Inj, propofol, 10 mg |
3,304 |
1,721 |
$42K |
| 84146 |
|
996 |
869 |
$42K |
| 81025 |
|
2,119 |
1,369 |
$41K |
| 85045 |
|
5,001 |
3,222 |
$41K |
| 84155 |
|
2,919 |
2,352 |
$41K |
| J2270 |
Morphine sulfate injection |
1,679 |
270 |
$41K |
| 99214 |
|
514 |
370 |
$40K |
| 82248 |
|
5,484 |
3,347 |
$40K |
| 78816 |
|
26 |
24 |
$39K |
| 76882 |
|
266 |
226 |
$39K |
| 97161 |
|
564 |
497 |
$39K |
| 96366 |
|
1,205 |
694 |
$38K |
| 77280 |
|
88 |
77 |
$38K |
| J0330 |
Succinycholine chloride inj |
475 |
353 |
$37K |
| 71045 |
|
728 |
507 |
$37K |
| J0612 |
Inj, calcium gluconate, nos |
352 |
127 |
$36K |
| 82306 |
|
1,780 |
1,519 |
$35K |
| J0689 |
Inj cefazolin sodium, baxter |
1,189 |
764 |
$35K |
| 86301 |
|
807 |
612 |
$35K |
| C1769 |
Guide wire |
487 |
361 |
$35K |
| 80048 |
|
1,212 |
710 |
$34K |
| 83520 |
|
2,521 |
1,123 |
$34K |
| 71271 |
|
232 |
201 |
$34K |
| J3489 |
Zoledronic acid 1mg |
552 |
415 |
$34K |
| 82533 |
|
949 |
683 |
$33K |
| J1100 |
Dexamethasone sodium phos |
6,131 |
3,415 |
$33K |
| J9263 |
Oxaliplatin |
1,142 |
389 |
$33K |
| 85730 |
|
2,391 |
1,481 |
$32K |
| J3010 |
Fentanyl citrate injection |
3,912 |
2,735 |
$32K |
| J9060 |
Cisplatin 10 mg injection |
742 |
295 |
$32K |
| 70543 |
|
63 |
52 |
$32K |
| C1726 |
Cath, bal dil, non-vascular |
118 |
98 |
$32K |
| 86304 |
|
439 |
345 |
$31K |
| 77387 |
|
212 |
40 |
$30K |
| 92597 |
|
414 |
328 |
$29K |
| 84550 |
|
3,531 |
2,044 |
$29K |
| 77080 |
|
333 |
280 |
$28K |
| J2250 |
Inj midazolam hydrochloride |
3,205 |
2,371 |
$28K |
| 77011 |
|
82 |
73 |
$28K |
| C1830 |
Power bone marrow bx needle |
241 |
182 |
$27K |
| J3475 |
Inj magnesium sulfate |
1,765 |
760 |
$27K |
| 84403 |
|
878 |
714 |
$27K |
| 82947 |
|
4,431 |
2,705 |
$27K |
| 85007 |
|
5,689 |
2,991 |
$27K |
| 82040 |
|
3,271 |
2,638 |
$26K |
| J9000 |
Doxorubicin hcl injection |
593 |
316 |
$26K |
| G0296 |
Visit to determ ldct elig |
369 |
343 |
$24K |
| J1720 |
Hydrocortisone sodium succ i |
494 |
339 |
$24K |
| 84703 |
|
2,000 |
1,365 |
$24K |
| 31237 |
|
18 |
13 |
$23K |
| 83540 |
|
2,971 |
2,530 |
$23K |
| 76377 |
|
215 |
195 |
$23K |
| 82670 |
|
421 |
326 |
$22K |
| 81001 |
|
2,987 |
2,114 |
$22K |
| C1788 |
Port, indwelling, imp |
86 |
76 |
$22K |
| 83001 |
|
571 |
450 |
$21K |
| 93005 |
|
917 |
687 |
$21K |
| 80197 |
|
907 |
316 |
$19K |
| 76937 |
|
298 |
238 |
$19K |
| 70450 |
|
86 |
66 |
$19K |
| 84075 |
|
2,986 |
2,406 |
$19K |
| J9305 |
Inj. pemetrexed nos 10mg |
320 |
75 |
$18K |
| 84450 |
|
3,050 |
2,434 |
$18K |
| 84460 |
|
2,949 |
2,373 |
$18K |
| 50200 |
|
27 |
13 |
$18K |
| 82247 |
|
3,038 |
2,418 |
$18K |
| 99215 |
Prolong outpt/office vis |
181 |
129 |
$18K |
| A9573 |
Inj, gadopiclenol, 1 ml |
1,252 |
1,123 |
$17K |
| 88112 |
|
401 |
326 |
$17K |
| J2001 |
Lidocaine injection |
1,005 |
742 |
$17K |
| 83021 |
|
368 |
223 |
$17K |
| 77001 |
|
201 |
160 |
$16K |
| 86800 |
|
801 |
688 |
$16K |
| J1453 |
Fosaprepitant injection |
379 |
188 |
$16K |
| J1200 |
Diphenhydramine hcl injectio |
2,770 |
1,455 |
$15K |
| 83970 |
|
548 |
333 |
$15K |
| J7999 |
Compounded drug, noc |
749 |
542 |
$15K |
| 83521 |
|
3,741 |
1,526 |
$14K |
| 83010 |
|
902 |
444 |
$14K |
| 88374 |
|
109 |
62 |
$14K |
| J1650 |
Inj enoxaparin sodium |
846 |
377 |
$14K |
| A9575 |
Inj gadoterate meglumi 0.1ml |
3,651 |
3,036 |
$14K |
| 86360 |
|
353 |
250 |
$13K |
| A9503 |
Tc99m medronate |
595 |
485 |
$13K |
| 88309 |
|
84 |
55 |
$13K |
| 77293 |
|
54 |
40 |
$13K |
| 71275 |
|
42 |
36 |
$13K |
| J1885 |
Ketorolac tromethamine inj |
1,384 |
676 |
$13K |
| 82024 |
|
184 |
156 |
$13K |
| 82105 |
|
830 |
669 |
$13K |
| 77470 |
|
17 |
13 |
$13K |
| 86870 |
|
89 |
38 |
$12K |
| 86880 |
|
502 |
265 |
$12K |
| C1729 |
Cath, drainage |
218 |
135 |
$12K |
| 83880 |
|
388 |
306 |
$12K |
| 88365 |
|
130 |
42 |
$11K |
| 87088 |
|
1,108 |
868 |
$11K |
| J0780 |
Prochlorperazine injection |
574 |
374 |
$11K |
| 82607 |
|
1,069 |
901 |
$11K |
| 87077 |
|
1,073 |
413 |
$11K |
| 94640 |
|
107 |
64 |
$11K |
| 83036 |
|
1,118 |
958 |
$10K |
| 82570 |
|
1,404 |
1,042 |
$10K |
| 88311 |
|
513 |
361 |
$9K |
| J2710 |
Neostigmine methylslfte inj |
124 |
78 |
$9K |
| 88173 |
|
156 |
100 |
$9K |
| 85652 |
|
1,245 |
960 |
$9K |
| 86706 |
|
528 |
437 |
$9K |
| 86704 |
|
633 |
510 |
$9K |
| J1644 |
Inj heparin sodium per 1000u |
875 |
532 |
$8K |
| 74160 |
|
33 |
29 |
$8K |
| G0008 |
Admin influenza virus vac |
321 |
253 |
$8K |
| 00731 |
|
71 |
60 |
$8K |
| 80061 |
|
833 |
686 |
$8K |
| 97530 |
|
101 |
52 |
$8K |
| 83002 |
|
220 |
176 |
$8K |
| 91322 |
|
93 |
75 |
$8K |
| 97760 |
|
156 |
138 |
$7K |
| 86803 |
|
658 |
531 |
$7K |
| 84305 |
|
119 |
97 |
$7K |
| 84484 |
|
701 |
473 |
$7K |
| J2371 |
Inj phenylephrine hcl 20 mcg |
757 |
505 |
$7K |
| 00940 |
|
20 |
12 |
$7K |
| 92567 |
|
188 |
123 |
$7K |
| 86140 |
|
1,042 |
777 |
$6K |
| J2920 |
Methylprednisolone injection |
217 |
124 |
$6K |
| J0690 |
Cefazolin sodium injection |
344 |
173 |
$6K |
| 84156 |
|
951 |
744 |
$6K |
| 88331 |
|
71 |
29 |
$6K |
| 87040 |
|
189 |
70 |
$6K |
| J7042 |
5% dextrose/normal saline |
172 |
107 |
$6K |
| 87070 |
|
287 |
198 |
$6K |
| J2405 |
Ondansetron hcl injection |
4,899 |
2,654 |
$5K |
| 83605 |
|
330 |
214 |
$5K |
| 86038 |
|
248 |
188 |
$5K |
| 87340 |
|
560 |
458 |
$5K |
| 84481 |
|
430 |
321 |
$5K |
| 93702 |
|
49 |
45 |
$5K |
| 82746 |
|
572 |
488 |
$5K |
| 83690 |
|
669 |
444 |
$5K |
| 74230 |
|
44 |
38 |
$5K |
| J0461 |
Atropine sulfate injection |
156 |
68 |
$5K |
| 92526 |
|
89 |
65 |
$5K |
| 97166 |
|
73 |
50 |
$4K |
| J2916 |
Na ferric gluconate complex |
19 |
12 |
$4K |
| 99195 |
|
50 |
38 |
$4K |
| 82550 |
|
516 |
365 |
$4K |
| 87389 |
|
199 |
165 |
$4K |
| 92611 |
|
54 |
54 |
$4K |
| J2060 |
Lorazepam injection |
459 |
224 |
$4K |
| 82043 |
|
394 |
344 |
$4K |
| 86316 |
|
163 |
142 |
$4K |
| 99203 |
|
57 |
51 |
$3K |
| 74220 |
|
37 |
28 |
$3K |
| 84702 |
|
227 |
186 |
$3K |
| J8540 |
Oral dexamethasone |
5,100 |
2,405 |
$3K |
| 00300 |
|
15 |
12 |
$3K |
| 82232 |
|
69 |
53 |
$3K |
| 86300 |
|
61 |
49 |
$3K |
| 87536 |
|
33 |
25 |
$2K |
| 51798 |
|
70 |
55 |
$2K |
| 81002 |
|
258 |
117 |
$2K |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
306 |
221 |
$2K |
| 81003 |
|
319 |
253 |
$2K |
| 85018 |
|
539 |
389 |
$2K |
| J1171 |
Inj, hydromorphone, 0.1 mg |
209 |
99 |
$2K |
| 85384 |
|
117 |
63 |
$2K |
| 90686 |
|
121 |
86 |
$2K |
| 90480 |
|
86 |
70 |
$2K |
| 85240 |
|
36 |
25 |
$2K |
| 87205 |
|
247 |
178 |
$2K |
| 0004A |
|
54 |
54 |
$2K |
| 96368 |
|
89 |
53 |
$2K |
| 87186 |
|
217 |
140 |
$2K |
| J0295 |
Ampicillin sulbactam 1.5 gm |
121 |
73 |
$2K |
| 82330 |
|
69 |
49 |
$1K |
| J1630 |
Haloperidol injection |
383 |
266 |
$1K |
| Q0162 |
Ondansetron oral |
1,202 |
551 |
$1K |
| 73502 |
|
12 |
12 |
$1K |
| 74018 |
|
36 |
27 |
$1K |
| 85014 |
|
319 |
231 |
$1K |
| 90662 |
|
73 |
60 |
$1K |
| J0736 |
Inj, clindamycin phosp 300mg |
23 |
15 |
$1K |
| J2003 |
Inj, lidocaine hcl, 1 mg |
218 |
181 |
$1K |
| 86644 |
|
32 |
26 |
$997.92 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
171 |
140 |
$923.62 |
| C1894 |
Intro/sheath, non-laser |
20 |
20 |
$866.45 |
| J2370 |
Phenylephrine hcl injection |
22 |
14 |
$824.16 |
| A9541 |
Tc99m sulfur colloid |
17 |
13 |
$823.19 |
| J9181 |
Etoposide injection |
35 |
12 |
$814.47 |
| 82150 |
|
153 |
90 |
$813.53 |
| 85397 |
|
14 |
12 |
$751.35 |
| J3420 |
Vitamin b12 injection |
76 |
52 |
$735.81 |
| 97763 |
|
15 |
14 |
$717.91 |
| 84132 |
|
114 |
69 |
$685.14 |
| 86431 |
|
52 |
47 |
$594.71 |
| 85049 |
|
79 |
44 |
$575.34 |
| 86480 |
|
13 |
12 |
$573.42 |
| 87449 |
|
24 |
12 |
$536.63 |
| 0002A |
|
16 |
16 |
$501.18 |
| J3260 |
Tobramycin sulfate injection |
28 |
12 |
$499.43 |
| G0009 |
Admin pneumococcal vaccine |
15 |
12 |
$465.92 |
| 83935 |
|
31 |
24 |
$382.43 |
| J0688 |
Inj cefazolin sodium, hikma |
60 |
42 |
$336.46 |
| 90656 |
|
28 |
26 |
$287.70 |
| 82977 |
|
27 |
24 |
$280.51 |
| L8000 |
Mastectomy bra |
55 |
29 |
$270.65 |
| J2004 |
Inj, lidocaine w epinephrine |
45 |
41 |
$255.90 |
| 85613 |
|
16 |
13 |
$252.18 |
| 0753T |
|
745 |
687 |
$244.30 |
| 84480 |
|
15 |
13 |
$239.50 |
| J3480 |
Inj potassium chloride |
20 |
12 |
$239.10 |
| J1642 |
Inj heparin sodium per 10 u |
774 |
411 |
$220.19 |
| 85670 |
|
16 |
13 |
$138.46 |
| 91300 |
|
107 |
106 |
$116.55 |
| J1920 |
Inj, labetalol hcl, 5mg |
142 |
95 |
$113.99 |
| 0754T |
|
285 |
269 |
$109.48 |
| Q0164 |
Prochlorperazine maleate 5mg |
269 |
155 |
$62.76 |
| J9370 |
Vincristine sulfate 1 mg inj |
17 |
12 |
$28.11 |
| J7512 |
Prednisone ir or dr oral 1mg |
63 |
38 |
$6.91 |
| G1004 |
Cdsm ndsc |
614 |
449 |
$0.03 |